Spritam — Cigna
Myoclonic seizures as adjunctive therapy
Preferred products
- generic carbamazepine (tablets, chewable tablets, ER tablets, ER capsules, oral suspension)
- generic divalproex (DR capsules, DR tablets, ER tablets)
- generic ethosuximide (capsules, oral solution)
- generic felbamate (tablets, oral solution)
- generic gabapentin (capsules, tablets, oral solution)
- generic lamotrigine (tablets, chewable tablets, ER tablets, ODT tablets)
- generic levetiracetam (tablets, ER tablets, oral solution)
- generic oxcarbazepine (tablets, oral suspension)
- generic phenytoin (ER capsules, chewable tablets, oral suspension)
- generic pregabalin (capsules, oral solution)
- generic rufinamide oral suspension
- generic tiagabine tablets
- generic topiramate (capsules, ER capsules, tablets)
- generic valproic acid (capsules, DR capsules, oral solution)
- generic vigabatrin (tablets, powder for oral solution)
- generic zonisamide capsules
- Roweepra
- Roweepra XR
Initial criteria
- If the patient has tried one Step 1 Product, approve a Step 2 Product.
- If the patient is currently taking or has taken Briviact at any time in the past and discontinued its use, approve Briviact.
Approval duration
1 year